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Organization
OC PATH MEDICAL GROUP
Active
Organization
OC PATH MEDICAL GROUP
Active
Other names
ORANGE REGIONAL PATHOLOGY ASSOCIATE
Organization subpart
No
Provider details
NPI number
Authorized official
JON P LAKE MD (PRESIDENT)
(714) 633-0011
Entity
Organization
Contact information
Practice address
3350 W BALL RD, ANAHEIM, CA 92804-3710
(714) 827-6701
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-3911
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
05D0582538
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
05D0582538
CA
Other
Enumeration date
01/07/2010
Last updated
05/03/2010
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